Tuesday, October 30, 2012

Epic Labor and Birth Story, part 2

If you read the previous blog and can do math you know that 88 hours after the initial signs of labor Josh and I faced the difficult decision to transport to the hospital. I was exhausted, frustrated, and had very little fight left in me. Josh on the other hand was so overly tired he just wanted to fight! He was worried that everything we'd hoped for our birth was about to be disregarded the moment we entered the hospital. Needing time to gather himself he stayed behind a few minutes while some friends came to pick up Fluffy and sent me in the car with our midwife Wendi.
Since we'd sent the family all home, it took a few minutes to notify them of the new development and so I arrived at the Osborn Birthing Center with Wendi and one of the student midwives, Donna.
En route Wendi had talked with me encouraging me to be open minded about an epidural and we discussed the hope that maybe a little pitocin would get the stalled labor to progress the final steps.
The birthing suite staff brought me directly to a birthing room bypassing the triage process thanks to a phone call from Wendi preparing them for our arrival. I was hooked up to the monitors and had an IV before I could blink twice. Unfortunately I had to pee 2 seconds later and had to be disconnected and then reconnected. And 2 seconds after that I had to pee again. Having to pee every 2 seconds was nothing new but in the freedom of my own home it didn't present to be a problem. I could quickly tell that it would be a problem now that we were at the hospital so in all seriousness I asked the nurses for a Foley catheter (a tube in my bladder to drain urine). The nurses apparently not used to that request smiled and nodded but took no action.
At some point Josh and other family began to arrive and were present when the on-call Dr came in and did a quick U.S. of Baby M. She told us that he was in a posterior presentation and informed us that there was only a 10% chance of delivering Baby M vaginally. This confirmed Josh's fears that the hospital was just going to "cut me open" and caused some outrage from him.

The news that he was posterior certainly explained the severe back pain (back labor) I'd started experiencing over the course of the last 90ish hours. At our last check Baby M had been LOA, left occiput anterior, the most desirable position for labor. He must have turned after my water broke...
The staff was working quickly completing the admission process and collecting data as well as drawing blood and monitoring the baby and I. At some point the question of an epidural came up and I answered "YES". With the potential of a c-section looming and/ or the introduction of pitocin, I couldn't see denying the comfort it would provide. The anesthesiologist that placed the epidural catheter was fast and the relief was almost immediate. For the first time in 4 days I suddenly had an appetite. I was starving! My husband and family had been trying to force feed me for over 3 days and I refused or vomited up almost everything offered. Suddenly I wanted one of everything! Crazy that once the pain diminished I was immediately hungry. Knowing the staff wasn't going to let me eat I went back to my other problem. I still desperately needed to pee. Alas the nurses finally gathered the equipment and placed a Foley. Ahh, for the first time in 4 days I no longer felt the urge to pee and the searing back pain that had started sometime during labor had finally ceased thanks to the epidural. Now that I was actually out of pain, I realized how much pain I had been in! Just remembering it brings tears to my eyes.
Not long after the epidural was placed the doctor came in and voiced concerns for Baby M. She was seeing something on the continuous fetal monitor that indicated he was finally getting tired of this epic labor as well. She told us that a c-section was inevitable and indicated the sooner the better. Our hopes for a home birth had already been crushed and now it looked like a vaginal delivery was out of the question as well. I asked the doctor if it was safe to take 10 minutes to talk with the family before going to the OR. She said it was and left us to talk.
I understood that a c-section was inevitable but Josh was tired and looking for a fight. He did not want to see my hopes of a vaginal delivery dashed and couldn't understand how things had gotten so messed up. Wendi took him aside and showed him the strips from the fetal heart monitor showing the decrease in Baby M's heart rate every time I had a contraction. She was patient and reassuring that at this point, a c-section was indeed the right action to take. It was so great to have the midwife team's continued support at the hospital.

After we'd all had time to adjust to the new plan, the staff got Josh and I prepared for the OR.
As they wheeled my bed out of the room towards the OR I said a tearful goodbye to the midwife team and reassured them that I'd be back with them for the next Baby M and had every intention of a delivering a VBAC (vaginal birth after c-section) for baby #2. I even promised Wendi I'd march with her to fight for the rights of midwives in Arizona to deliver VBACs. It seems overly dramatic but picture William Wallace's speech at the end of Braveheart, that's the passion I was channeling!
The next part is so surreal. Being wide awake for surgery is just bizarre. Especially having a strong medical background. Josh stood at my head next to the anesthesiologist and held my hand. I'd started shivering by then and was reassured that it was a normal reaction to the epidural drugs. I talked with Josh and translated the medical jargon. The c-section took a long time. Much longer than I'd anticipated. There was a resident in the room and the doctor had been talking to him throughout the procedure. The tone of the conversation changed and I began to wonder what was going on. Things were taking a while and Josh was getting bored so he began to look over the blue drape to see the action.
He even managed to sneak a forbidden picture.
After what felt like ages they managed to free Baby M from my uterus at 12:51 am. They respected our birth plan and called Josh over to identify Baby M's gender to announce it to me. Josh said, "It's a Myles. We have a Myles!", choosing to disclose the gender by using our chosen boy name.
I could hear his weak little cry while Josh turned his attention to Myles and snapped this picture.
The perinatal specialist told us that Myles would need to go to the NICU due to a low APGAR score and requiring supplemental oxygen at delivery. Josh left with Myles while the surgeon finished closing me up. Other than what the specialist told me I knew very little about Myles but I did get to spend a few seconds with him and could tell he was a big strong boy. Seeing that, I had very few fears about him needing the NICU.
The c-section had already taken much longer than I'd thought it would and then I found myself lying on the OR table for ages while she closed the layers of incisions she'd made. By now I was shivering violently and even though the anesthesiologist had covered my upper body with warm blankets, I'd literally shivered them off and onto the floor! Then a huge wave of nausea hit and I found myself dry heaving and shivering miserably. I began to feel lonely in the OR but knew that Josh was with Myles. I'd thought to ask for my mom to come in but I kept thinking that they would be done any second.
After ages they finally finished and brought me to the recovery room. Once there the perinatal specialist came and talked to me about Myles. He told me that Myles wasn't properly breathing when they extracted him and since it took a bit of effort to get him going he would need to stay the night in the NICU. He also told me Myles was 8 lbs 5 oz and 22 inches long. Again, what I heard was that he was a big strong boy and despite needing a little help initially, I was confident he would be just fine. Not long after my surgeon came in and explained the lengthy duration of my c-section. She explained that my uterus had been inappropriately squeezing down on Myles and that in combination with a severe shoulder dystocia had made extracting him difficult. She told me that she had to perform a vertical uterine incision in addition to the typical transverse. She explained that because this vertical incision was extremely long, I would not be a candidate for VBAC, and she did not think my uterus would hold up for a large family. She reassured me that we would be fine having a second child, but recommended I schedule a c-section by 37 weeks to avoid natural contractions and carrying another large baby in my fragile uterus.
I have to admit, I'm not sure if this news has even set in to this date. I understand the words. I will never know the experience of a vaginal delivery. Since that night I've followed up with the doctor and discussed this. She reassured me that I'd experienced enough labor for 3 deliveries and had truly only missed the "pushing" stage. I'm really still wrapping my mind around this but I'm thankful that at least I'll be able to have another child when we're ready.
Josh continued to stay with Myles in the NICU while I was in recovery. I chatted with my nurse who was very supportive and kind. She relayed some crappy news. Item 7 on my birth plan, "I have big plans for my big placenta, please do not dispose of it" had been neglected. After several reminders from Josh, the surgeon, and I, while we were in the OR, the staff likely in autopilot mode added a toxic preservative to my placenta. It was no longer safe for my intended use, placenta encapsulation.
Meanwhile Josh was in the NICU watching other pieces of our birth plan regarding Myles get disregarded. We'd hoped to avoid or delay antibiotics, blood draws, or invasive procedures but all of that was now necessary since he was in the NICU. I understood this but Josh continued to take this hard. He was there to see poor Myles hooked to monitors and getting poked with needles to get IV's placed.
Just a few days ago I saw the pictures taken during this time and cried. So little and so much chaos in the first hours of life! I had envisioned our first hours to be spent together snuggling and nursing in our own bed in our own home. I had never entertained that I wouldn't even be able to hold my child for hours!
After several hours in recovery I was wheeled into the NICU with my mom and Josh and was able to see and hold Myles. He was so big and just perfect!
I wanted to continue holding him but his alarms began to chime and although I could tell it was a false alarm, the nurse ran over to assess him and I didn't have it in me to argue with her. She didn't want us to "stimulate" him and encouraged us to go after the briefest visit.
Josh and I got to our hospital room around 4 am Thursday morning. Four complete days after the start of this journey. We were beyond tired and had just enough left in us to hold each other and cry over all we'd gone through.

Final part to come...

Monday, October 29, 2012

Epic Labor and Birth Story

Let's face it the word epic has been chronically overused for quite some time now but when trying to title this blog it is truly the only word that can begin to describe my 90(ish) hour ordeal. I will vow to officially retire the word epic after this post.

Many of you may know that we planned for a home birth and worked with a fabulous pair of midwives (Freedom and the Seed) and their staff. Our due date (Sept 24) was rapidly approaching and Josh and I anxiously prepared the house and the birthing tub in anticipation.
Labor started around 3am on Sunday September 16. I'd gone to sleep that night after having tons of Braxton Hicks (BH) contractions in the evening but that was really nothing new. Waking up to contractions however was a completely new experience. I got out of bed, drank a ton of water, took a warm bath, and did a little walking around to see if the contractions would go away like BHs usually do but after about an hour and 1/2 they were still there and coming regularly. I figured I'd better place a sick call to work and wake up Josh to let him know what was happening. Since things were just getting started I texted the midwives to let them know things were getting started. They wisely responded that since I was a first time mom, we likely had lots of time ahead of us and told us to stay in touch.
Sunday was a great day. I remember watching TV shows/ movies with Josh (although I can't remember which ones), and taking walks around the block with Josh and Fluffy. I may have eaten some small snacks that day but remember feeling a little nauseated. Sunday night we got a little sleep, dozing on the couch between contractions.

Josh and Fluffy didn't seem to mind the contractions much and slept pretty soundly

After continuous mild contractions during the night, Monday morning Josh and I decided we needed to get the show on the road. We walked around the block without much improvement and while I was pacing around the backyard moving from tree to tree between contractions, I decided it might help to mow the yard. Activity + a great place to rest during contractions.

Josh says I did a shitty job mowing and I only got 1/3 of the yard done before it got too uncomfortable

Sometime on Monday I lost my mucous plug. We contacted the midwives to let them know how often contractions were coming and that I'd lost my plug but contractions weren't coming frequently enough for "active labor" so we decided to see the office chiropractor, Dr Dawn Tames, to see if she couldn't help get things moving. About 15 minutes of working with Dawn and my contractions really intensified. And I mean REALLY. They got stronger, closer together, and next thing I knew I was on all fours crying and vomiting into the office trash can. (I'm still sorry Dawn!) Dawn said something that made it worth while. She exclaimed "Now that's active labor!" Luckily my mom had done the driving and got me home, the first of many uncomfortable car rides. Contractions + seat belts + vomiting don't go well together.
Monday evening we had a few visitors. Family and friends checking in to see how things were going. I also got into the birth tub for the first time. I learned quickly the miracle of warm water on the labor pains. I got immediate relief from the discomfort but also noticed that the contractions would slow down a bit. They seemed to pick up after getting out of the tub so I wasn't too worried.
Late Monday night while in the tub, I felt a huge rush of water that was NOT coming from the jets in the tub. My water broke. We called the midwives and not long after got a visit where I had my first internal check. 2cm dilated. What??? After 2 days of labor? Knowing that we still had quite a ways to go to get to 10cm I sent the gals from FATS home.
After another night of minimal sleep, Tuesday brought another day of labor. By now pain and nausea had made it difficult to eat and I'd hardly been able to take in any food. Josh kept me supplied with water and Hammer Perpetuem (one of my tried and true race fuels). More visits from family and some much needed time trying to get through the contractions in the birth tub.
Every once in a while the contractions would really die down and I'd try to "rest" in bed where I could "relax" through the contractions.

Fluffy was always near to help me cope.

I was getting frustrated and uncomfortable and after talking with the midwives decided to see the chiropractor again as well as get another exam to see how much progress there had been. A trip to the office and Dawn had the contractions raging again and then a visit with the midwives where I tearfully cried out, "My body isn't doing what it's supposed to!", I learned that we were now 7cm dilated. A huge relief that progress had been made, I left thinking I'd be holding my baby by the end of the night!
The midwives also believed that things were progressing and sent Ashley, a student midwife to the house to monitor the progress and keep track of baby M's vitals along with mine.

Tuesday night was yet another sleepless night where Josh and I paced, changing from position to position and did our best to move this labor along.

Wednesday morning came and yet there was still no baby. We were comforted by the presence of the midwife team and Donna came to relieve Ashley so she could rest and tend to other tasks. With Donna's arrival, I redirected my energy and focus and proudly stated that I would deliver this kid by 6:30 pm. No more "lounging" in the birth tub or taking brief naps between contractions. I stated I would not take a break until I was holding my kid!

I labored.

and labored...

and labored...

There honestly wasn't an inch of this house that I did not labor in. I used my husband for support, my mother for support, my sister for support, and the midwife team including Dr Dawn who came to the house to help out. We tried back rubs, counter pressure, squatting positions, leaning positions, inverted positions, sidelying, and hands and knees. I tried sitting on the toilet, I paced, and even tried walking the neighborhood but never got very far due to discomfort. By now we had family on standby thinking things were going to happen any time. Even the neighbors were watching anxiously!
By late afternoon I had half the staff from Freedom and the Seed at the house monitoring the progress and keeping tabs of our vital signs. Having consumed minimal calories and getting very little sleep for several nights now everyone was worried about me fatiguing. Up to this point I had been confident and continued to insist I would get the kid out by 6:30 pm. Baby M's HR was great and my vitals and temp showed no signs of concern so the midwives continued to support our hopes for a home birth although we were all beginning to wonder why my labor continued to crescendo and then stall, repeatedly.
Hoping to get my labor on track once and for all the midwives talked with Josh and I and we decided to ask our family to leave the house so that we could get focused. We hoped that without any distraction or concerns about modesty I might get passed the continued stalling. This was a tough decision but we were desperate and willing to try anything. It was time to get primal, get loud, dig deep, and push this kid out!!!

I remember acknowledging 2 fears around this time. The first, that my body just wasn't working right. The 2nd, that I was handling the labor pains poorly (being a big wuss).
Once again, with the help of the midwives and the chiropractor, we got the contractions raging. They were big, long, painful, and coming closer together. Could this be it? At one point I remember asking, "When is this going to end?", and getting the response that it "was up to you". I continued to work through the surges but that statement repeated in my head over and over.
As the sun set and night began to fall I realized I was tired. Very tired. My 6:30 pm goal had come and gone and I realized that if getting this kid out was up to me, I would have delivered the kid 3x's over by now. I really felt like I'd done the work, all I could do. I came to the realization that it may be time to think about transporting to the hospital. Josh and I moved to the bedroom so that I could take a much needed "rest" and we talked it over. With tears we had a short conversation with the midwife team and we began packing for the hospital.
see part 2